- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $756.00 / $2,418.00 / $4,392.00
| Facility | | $756.00 | $2,418.00 | $4,392.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,062.09 / $7,362.58 / $13,982.44
| Facility | | $4,062.09 | $7,362.58 | $13,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.92 / $1,778.86 / $1,778.86
| Facility | | $1,061.92 | $1,778.86 | $1,778.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $400.00 / $400.00
| Facility | | $400.00 | $400.00 | $400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.00 / $3,238.00 / $9,160.00
| Facility | | $882.00 | $3,238.00 | $9,160.00 |